1. Personal Health Information: The Last Frontier on the World Wide Web James J. Cimino, M.D., Soumitra Sengupta, Ph.D., Eneida Mendonça, M.D., M.S., Department of Medical Informatics Columbia University Vimla L. Patel, Ph.D., Andre Kushniruk, Ph.D. Centre for Medical Education, McGill University

2. Things You Can Do On the Web Read a newspaper Buy groceries Banking Trade stocks Track your Fed Ex package Get health information

3. Kinds of Health Information You Can Get Medline citations Drug advertisements Quack therapies Viagra prescriptions

4. Kinds of Health Information You Can’t Get Your cholesterol level Your mammogram report A list of your current medications Advice from your doctor

5. Personal Health Information on the Web Access to your electronic medical record Ability to contribute to your medical record Relevant, reliable, understandable advice Fostering patient-clinician communication

6. Challenges Web access to electronic records Security and confidentiality issues Political issues Ethical issues

7. Web Access to Electronic Records Data in electronic form? Data accessible? Data queries Presentation Writing to record

8. Security and Confidentiality Issues Identification Authentication Authorization Privacy

9. Political Issues Clinician response Medicolegal issues Institutional Review Board

10. Ethicial Issues Discovery without supervision Misunderstanding and worry Misunderstanding and complacency Patient-clinician communications –better –shorter –worse –longer

11. PatCIS: An Experiment to Gain Experience Funded by the US National Library of Medince Architecture Applications

12. PatCIS Screen shot

13. Data Entry Review Advice Education Comments Help Logout Java script Vital SignsBlood Sugar Data Entry patcis.cgi Web Server Web Browser Session Registry Re-enter Password Usage Log Internet Javascript Link 1 2 3 4 5 6 7 8 9 10 CGI 11

14. PatCIS Architecture Integration Security Tracking Evaluation Feature blocking

15. PatCIS Domains Data entry Data review Education Advice “Infobuttons”

16. Data Entry screen shot

17. Data Review graph? More screen shots

18. Mammogram Advice screen shot

20. more screens

21. Current Experience Small number of users No problems thus far Favorable response Evaluation under way

22. Potential Areas of Expansion Advance directives Pap smear infobutton

23. Addressing the Challenges Web access to records Security and confidentiality issues Political issues Ethical issues

24. Conclusions